Unusual pediatric co-morbility: autoimmune thyroiditis and cortico-resistant nephrotic syndrome in a 6-month-old Italian patient
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We report on a case of autoimmune thyroiditis in a 6-month-old patient with cortico-resistant nephrotic syndrome. Normal serum levels of thyroid hormons and thyroid-stimulating hormone were detected with high titers of circulant antithyroid antibodies and a dysomogeneous ultrasound appearance of the gland, typical of autoimmune thyroiditis. The research of maternal thyroid antibodies was negative. This is the first case of autoimmune thyroiditis found in such a young patient with pre-existing nephrotic syndrome ever described in literature. This association is random because nephrotic syndrome does not have an autoimmune pathogenesis and the genes involved in autoimmune thyroiditis are not related to those of nephrotic syndrome.
KeywordsAutoimmune thyroiditis Nephrotic syndrome Childhood
Autoimmune diseases are very rare conditions in infancy, especially in the first year of life[1–4]. We report on a case of unusual early-onset autoimmune thyroiditis in a 6-month-old child affected by nephrotic syndrome. Before that, a case of isolated autoimmune thyroiditis has been reported previously at a so early age: the patient, a 7-month-old child, died at the age of 9 months for a sepsis and his autopsy revealed a thyroid atrophy.
After a month a blood assay revealed the persistence of high titers of antithyroid antibodies associated to a slight decrease of thyroid hormones (fT4 0,62 ng/dl with normal values between 0.70 and 1.80, fT3 1,32 pg/ml with normal values between 1.7 and 5.2) and normal levels of thyroid-stimulating hormone, without any clinical sign of hypothyroidism. Because of the aggravation of the renal disease, the patient was transferred to another hospital where he continued human albumin replacement therapy and cyclophosphamide and than he began haemodiafiltration. During this period he was subjected to renal biopsy which demonstrated the presence of a focal and segmental glomerulonephritis with mesangial matrix proliferation and an increase of Immunoglobulines M. Currently the patient is undergoing peritoneal dialysis waiting for kidney transplantation.
The significance of this study is due to the early onset of autoimmune thyroiditis in association with nephrotic syndrome in a child under one year of age. The association found in our patient seems to be random because nephrotic syndrome does not have an autoimmune pathogenesis and there is no genetic or antigenic relation between autoimmune thyroiditis and nephrotic syndrome[8–10]. Finally, the case described suggests that serum thyrotropin and thyroxin levels should be determined in all cases of renal failure, even if the patient does not present the clinical signs of hypothyroidism.
Written informed consent was obtained from the patient’s parents for publication of this case report and any accompanying images.
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